Making CPR decisions

Your view about whether you would like cardiopulmonary resuscitation (CPR) to be attempted is important. Ideally you would be able to talk this over with your family and healthcare team and come to a decision before a cardiac or respiratory arrest occurs. But if you haven’t made a decision then your doctor will decide based on medical grounds.

If you don’t want CPR to be attempted your decision is final. If you are sure you would like CPR to be attempted, your healthcare team will take your wishes into account. But a senior doctor can decide not to attempt CPR if they feel it’s not appropriate.

If you haven’t made a decision about CPR and you do experience a cardiac or respiratory arrest your doctors will discuss CPR with your family or next of kin. They will try to find out your views on CPR and make a medical decision based on this.

Once you have made your decision, the doctor will tell the rest of the healthcare team. This information is confidential.

Making decisions about CPR

Your healthcare team should involve you as much as possible when making a decision about CPR. You may need time to think carefully about your situation. Think about what would be best for you if your heart and breathing stopped. Your team will consider your wishes about CPR. However, the final decision will be made by a senior doctor. They will think about the benefits and risks of CPR for you.

They will tell other members of the team that you have discussed CPR and what decision has been made. This information is confidential. It will only be shared with the team caring for you.

If you have told your healthcare team that you do not want CPR, they will accept your decision.

You may decide that you want CPR even if your healthcare team tells you it is unlikely to work. If you do not agree with your team’s advice, you can ask for a second medical opinion from another senior doctor. It is important to be aware that another doctor may have the same opinion as your healthcare team.

Sometimes, the healthcare team may decide that the person is not able to make the decision about CPR themselves. For example, this may happen if someone has a serious mental health illness, or is confused or disorientated.

Some people do not want to make their own decision about CPR. You do not have to talk about CPR with anyone or decide about CPR if you would prefer not to. Instead, you can let your healthcare team decide for you.

Recording the decision

The decision about CPR will be written clearly in your medical and nursing notes. If the decision has been made not to give CPR, this is written as a 'do not attempt resuscitation' (DNAR) order, or as a 'not for resuscitation' (NFCPR). The doctor usually also writes a date to review the decision in the medical notes. This means that the decision will be discussed again to check it is still correct and up-to-date. For people with advanced cancer, the doctor may write that the decision is indefinite.

If you are in hospital, the decision will be written in your medical and nursing notes. But they will not be in any notes stored beside your bed. If you leave the hospital ward, for example for an x-ray, your medical notes usually go with you. Many hospitals use stickers on the outside of medical notes to show that CPR should not be given. This helps any person looking after you find this information quickly. Your team will also aim to communicate clearly with staff in other departments. Anyone involved in your hospital care should know about a CPR decision.

If you go home from hospital, the community healthcare team looking after you should also be told about a CPR decision. This includes:

  • your GP
  • your local out-of-hours service
  • the ambulance service.

It may also include:

  • the community palliative care team
  • the district nurses
  • any carers.

Sometimes the DNAR decision will be written on a form that you can take home with you. If you are being cared for at home, check if the community healthcare team will accept the form. You will need to keep it in a safe place at home.

GPs or community palliative care teams will usually discuss CPR with the people they are looking after. But if they have not and you want to discuss it, ask to talk to them.

If no decision has been made

If your heart or breathing stops, your healthcare team will make the best decision they can at the time if:

  • you have not already made a decision
  • it is not clear what the decision is.

They will decide whether to give CPR based on your medical situation. If your heart or breathing stops at home and an ambulance is called, the paramedics will always give CPR. This is unless there is a clearly written DNAR or NFCPR order.


Can I insist that I am given CPR?

You may decide that you want to be given CPR even if your healthcare team tells you it is unlikely to work. Your team will consider your wishes about CPR. However, the final decision may be made by a senior doctor.

If you don’t agree with your team’s advice, you can ask for a second medical opinion from another senior doctor. Your doctor or GP can tell you more about getting a second opinion.


What if I am unable to make a decision about CPR?

In some situations, you may not be able to make a decision about CPR. For example, this might be if you are unconscious or too drowsy from medication.

If this happens, your healthcare team will make any final decision about CPR. They will think about your medical situation carefully. They will also talk to people close to you, such as your next of kin or family. This is because these people may be able to suggest what decision you would make.

If you have asked your healthcare team not to discuss your care with certain people, they will respect this. They will not discuss the CPR decision with those people.

You may have arranged for someone to help make decisions for you if you are unable to. In England and Wales, this person is called a health and welfare attorney. They must be named in a legal document called a lasting power of attorney (LPA). In Scotland, this person is called a welfare attorney. They must be named in a legal document called a power of attorney (PoA).

Your healthcare team must discuss any decision about CPR with your attorney. However, if the healthcare team decides giving CPR will do you more harm than good, your attorney cannot demand treatment.

In Northern Ireland, attorneys do not make decisions about medical treatment. However, your next of kin or relatives should still be asked for advice about the decision.


Recording your decision about CPR in advance

An Advance Decision to Refuse Treatment (ADRT) is a written statement of your wishes to refuse a particular treatment in a specific situation. It is called an Advance Directive (AD) in Scotland. It is a way of making sure that everyone knows in advance if there is a treatment you do not want to have.

Before making an ADRT or AD, it is important to discuss it with a healthcare professional. This may be your GP, or a doctor or nurse specialist looking after you at the hospital. They can tell you what might happen if you stop a particular treatment or decide not to have it. They will also make sure your written statement meets legal requirements.

If you decide that you do not want to be given CPR, you can record this in your written statement. A copy can then go into your medical notes for your healthcare team.


Will a decision about CPR affect the rest of my treatment or care?

A decision about CPR will not affect any other care or treatment that you get.

Each time you are admitted to hospital, a doctor will check the CPR decision and discuss it with you. This is important because your medical condition or decision may change.

You may change your mind and want to review your decision. You will need to talk to your healthcare team about this. If there is a change following your discussion, your doctor will record it in your medical notes. Remember to tell your family or carer about any changes to avoid confusion.

If you would like to know more about CPR, you might find it helpful to look at the website TalkCPR.


What happens if I change my mind about CPR?

You can change your mind about CPR at any time. If you do, it’s important to tell a member of your healthcare team. If you make a new decision with your healthcare team, they will record it in your medical notes. Remember to tell your family or carer about any changes to avoid confusion.

Back to Coping with advanced cancer

Decisions about treatment

You may have lots of questions about your treatment options. You can talk to your doctors and nurses about these.

Who can help?

You can get care and support at home, in a hospital or in a hospice. This depends on your needs and preferences.

What is CPR?

Cardiopulmonary resuscitation (CPR) can be used to try to restart the heart and breathing if they have stopped.